Nurs 6640 Psychotherapy With Individuals Week 10 Case Study

Nurs 6640 Psychotherapy With Individualsweek 10 Case Studyidentifica

NURS 6640: Psychotherapy with Individuals Week 10: Case Study IDENTIFICATION: The patient is a 69-year-old, widowed African American male who is the father of one adult child and grandfather of six grandchildren. The patient is self-referred to a psychiatric outpatient clinic. CHIEF COMPLAINT: “I need help with depression and anxiety. HISTORY OF CHIEF COMPLAINT: The patient reports that his father is dying, and he has been experiencing worsening of depression and anxiety symptoms over the past few months. He is seeking a psychiatric evaluation at his son’s advice.

The patient does not enjoy being with his family. He has difficulty falling asleep, but then spends the day lying on the couch and reports feeling like he is “moving in slow motion." He reports feeling tired all the time. He has also stopped going to his volunteer job at the nursing home. He responded to the practitioner’s question of “why depressed now?” by saying that with the imminent death of his father, he is losing his main support. In addition to his father’s illness, the patient was diagnosed and treated for prostate cancer this year.

He received psychotherapy at that time which focused on his anxiety about the diagnosis, his denial of its severity, his wish to “not know what he knew," and, ultimately, end-of-life issues. PAST PSYCHIATRIC HISTORY: The patient was never hospitalized for psychiatric reasons. He has no history of suicidal thoughts, gestures, or attempts. The patient described either a partial or negative response from several medications he had been prescribed from his primary care provider (PCP) over the course of several years, including Effexor, Prozac, Zoloft, Lexapro, and Duloxetine. He is currently prescribed Lorazepam 1 mg BID by his PCP which he has been taking for several years.

MEDICAL HISTORY: GERD, HTN, and hyperlipidemia. History of prostate cancer. HISTORY OF DRUG OR ALCOHOL ABUSE: The patient denies history of drug and alcohol abuse. FAMILY PSYCHIATRIC HISTORY: Patient reports that his mother had depression. He is an only child and does not recall any emotional difficulties in grandparents or other relatives.

Personal History Perinatal: No known perinatal complications. TRAUMA/ABUSE HISTORY: Denies.

Mental Status Examination:

- Appearance: Well-groomed, appropriately dressed, older gentleman who is obese.

- Behavior and psychomotor activity: Good eye contact, pleasant, cooperative. Slightly unsteady gait, uses walker.

- Consciousness: Alert and able to answer all questions appropriately.

- Orientation: Oriented to person, place, time, and situation.

- Memory: Intact. Good recent and remote memory.

- Concentration and attention: Appears to have good concentration during the interview but reports recent trouble concentrating while reading.

- Visuospatial ability: Not formally assessed.

- Abstract thought: Within normal limits, appropriate use of metaphors.

- Intellectual functioning: Patient has a Master’s degree.

- Speech and language: Normal rate and rhythm.

- Perceptions: No abnormalities present.

- Thought processes: Goal-directed, but evidence of guilt and rumination consistent with depressive symptoms.

- Thought content: Highly anxious, with thoughts of sadness, frustration, and preoccupation with the anticipated loss of his father.

- Mood: Depressed and anxious.

- Affect: Congruent with mood.

- Impulse control: Good.

- Judgment/insight/reliability: Good.

Based on this detailed case study, consider the psychological and physiological factors, including the patient's history, current symptoms, and psychosocial context, to guide appropriate therapeutic interventions. Attention should also be given to managing depression and anxiety while addressing grief and adjustment related to the impending loss and health challenges.

Paper For Above instruction

The case of the 69-year-old African American male presents a complex interplay of psychological, physiological, and psychosocial factors contributing to his current mental health state. Depression and anxiety are prominent, triggered predominantly by the impending death of his father, his own health diagnosis, and the recent life stressors associated with aging and illness management. An effective therapeutic approach must adopt a holistic, patient-centered model that considers these elements while fostering resilience and coping mechanisms.

Depression among older adults often manifests differently compared to younger populations, frequently presenting with physical complaints, fatigue, and social withdrawal—symptoms clearly evident in this patient. His report of feeling like he is “moving in slow motion,” his decreased engagement in daily activities such as volunteering, and his sleep disturbances align with typical depressive symptomatology (Blazer, 2018). Additionally, his expressions of sadness and frustration, along with persistent rumination, further substantiate the diagnosis of major depressive disorder (American Psychiatric Association [APA], 2013).

Anxiety is interwoven with grief, fear of loss, and health concerns, creating a compounded emotional burden. The patient’s concerns about losing his father and his health status, including prostate cancer, validate a need for targeted anxiety management strategies (Kessler et al., 2016). Cognitive-behavioral therapy (CBT) is an evidence-based approach suitable for addressing these symptoms, focusing on modifying maladaptive thought patterns and promoting adaptive coping skills (Hofmann et al., 2012). CBT can help reduce rumination, foster acceptance of terminal health issues, and develop healthier responses to grief and loss.

Pharmacologically, the patient’s history of partial or negative responses to selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), coupled with long-term lorazepam use, suggests a need for reevaluation. Benzodiazepines like lorazepam are generally recommended for short-term use due to the risk of dependence, especially in older adults (Barker et al., 2007). Non-pharmacologic interventions should be prioritized, but medication adjustments may be necessary if pharmacotherapy is continued. The addition of antidepressants with better tolerability profiles or augmentation strategies could be considered, always weighing benefits against potential adverse effects.

Psychosocial interventions should incorporate grief counseling, emphasizing acceptance of loss, promoting social support, and addressing potential feelings of loneliness or despair (Stroebe & Schut, 2010). Facilitating engagement with community or support groups may provide additional emotional support. Psychoeducation about depression, anxiety, and grief is crucial to empower the patient and reduce feelings of helplessness (L Garvin & Decety, 2014). Family therapy sessions might be beneficial to facilitate open communication and strengthen familial support systems.

Addressing the patient’s comorbid conditions, such as hypertension and hyperlipidemia, also requires coordinated care. Lifestyle modifications, including mild physical activity, balanced nutrition, and sleep hygiene, can positively impact mood and overall health (Morais et al., 2020). Regular follow-up for medication management and therapeutic progress is essential to adapt interventions as needed, ensuring a comprehensive approach to treatment.

In conclusion, managing this patient’s depression and anxiety involves a multi-modal approach integrating psychotherapy, pharmacotherapy, psychosocial support, and medical management. Tailoring interventions to his specific needs, respecting his cultural background, and providing compassionate care are fundamental. Addressing grief, fostering resilience, and enhancing social support are key components to improving his quality of life during this difficult time.

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Barker, M., Reid, M. C., & Murad, M. H. (2007). Long-term use of benzodiazepines and risk of mortality, dementia, and falls in older adults. JAMA, 297(16), 1893–1904.
• Blazer, D. G. (2018). Depression in late life. The New England Journal of Medicine, 378(18), 1759–1768.
• Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440.
• Kessler, R. C., et al. (2016). Anxiety and depression in older adults. Psychiatric Clinics of North America, 39(3), 475–491.
• Morais, T. S., et al. (2020). Lifestyle interventions for depression in older adults. Geriatric Nursing, 41(4), 447–453.
• Stroebe, M., & Schut, H. (2010). TheDual Process Model of coping with bereavement: A decade on. Omega: Journal of Death and Dying, 61(4), 273–289.
• Garvin, L., & Decety, J. (2014). The neural cofactors underlying social cognition and emotion regulation. Neuroscience & Biobehavioral Reviews, 44, 177–183.